The announcement of large spikes in health care premiums for school and town employees is generating a lot of concern among taxpayers. Insurance companies are raising our premiums because they can’t make money on their investments. Since Wall Street trashed the financial system, stocks and bonds and money markets pay practically nothing. Take a look at your savings account since 2008 and you’ll see the problem.

Insurance companies can do this because we the people don’t have the expertise to comparison-shop for doctors, hospitals, medications or treatments the way we might for a car or computer. We can’t pay for major care out of pocket, so we must rely on insurance, thereby losing the final say in what to buy or how much to pay for it. Markets work only when consumers have the power to say no if the price isn’t right. It’s pretty hard for anyone to say no in the case of things like end-of-life care or brain surgery, let alone childbirth or infections.

Because the market is not free, insurers can raise our rates whenever they need to. This guarantees them generous salaries and profits for their investors. All we can do is pay — for now. But if we hold our legislators’ toes to the fire and make them follow through with a real single-payer health system, all that will change.